As the little league season is upon us, there is quite a buzz these days on injury prevention and year round throwing in the youth baseball player. Over the last couple of years, I have seen quite an increase in youth injuries in the 10 to 13-year-old range from kids playing baseball either year round, playing in two leagues at the same time or both. At this age injuries manifest in the elbow mostly due to overuse, improper throwing mechanics and also because of skeletal immaturity. Injuries such as medical epicondyle avulsion fractures and UCL strains are amongst the most common for this age range. The severity of these injuries are on the rise and what most parents and kids do not understand is that while we as a medical community have evolved and are great at helping to correctly these injuries, it still does not negate the fact that if these kids continue to play year round and in multiple leagues at the same time, their chances of making it beyond high school in baseball decrease to a generous 10%. I am a huge advocate for the STOP program that Dr. Andrews has begun to spread awareness of the potential hazards associated with overuse in youth sports. There is also a program started by MLB called Pitch Smart and an app developed by Dr. Andrews and Kevin Wilk out of ASMI called Throw Like a Pro, all to help promote following pitch counts and smart baseball habits. I make sure parents and athletes that I am treating are well versed in the pitch count and throwing regulations for youth baseball. I want parents and kids to understand that until they have a skeletally mature system, there are several things they should and should not be doing:

1. Do not play year round. I advocate 4-6 months off from baseball for 10-12 year olds and 4 months on for 13-14 yr old, and 3 month off for 15-18 yr olds. However with all the camps and showcases for high school athletes this can be nearly impossible.
2. Do not play on multiple teams. One team per season, do not cross over end of one season and beginning of another. If you have a break in between seasons (1 week to 4 weeks) take the time and proper steps to progress back into throwing and hitting.
3. Do not play pitcher and catcher in the same game or same day if playing multiple games. Be an advocate for your child, do not let coaches over utilize the kids during games and tournaments even if they are short on players. Nothing good ever comes out of this tactic for the athlete.
4. Avoid the training programs that require exercises and weighted ball activities that their system is not strong enough to handle. Volume, distances, weights, and exercises all need to be modified and reduced for the 10 to 13-year-old group.
5. Develop basic scapular stability. Most 10 to 13-year-olds have some baseline scapular dyskinesis due to skeletal immaturity and you can not develop full stability until you age. Focus on basic stability and only perform what bodies can handle until they mature.
6. The Thrower’s Ten program is a great program for this age range with no weights and light resistance bands. It is easy to perform with little to no equipment, compliance is high and it is not overtaxing on their system.

There are also some good basic throwing mechanics as described by Davis JT et al* that I review with this age group. Davis describes, for the youth these basic checkpoints are useful to help develop more efficient throwing until they achieve proper sequence of motion as they age:

1. Leading with the hips
2. Hand on top position
3. Arm in throwing position: elbow max height when lead foot contacts
4. Closed shoulder position
5. Stride foot towards home plate

This study by Davis et al concluded that hand on top and closed shoulder position are 2 parameters the pitcher should achieve to reduce humeral internal rotation torque and elbow valgus loads. A basic arm prevention program, volume control and basic mechanics instruction can have a positive impact in reducing the injury epidemic in the young baseball player.

Join Angela for Advanced Concepts for The Overhead Athlete in Colorado next summer.

–Angela Gordon, PT, DSc, MPT, COMT, OCS, ATC, FMS Lead physical therapist for the Washington Nationals Baseball team & NAIOMT Guest Faculty Member

*Davis JT, Lumpisvasti O et al. The Effect of Pitching Biomechanics on the Upper Exremity in Youth and Adolescent Baseball Pitchers. Am J Sports Med. 2009:37:1484-1489.